20例妊娠合并甲状腺功能减退的病因及治疗  

Possible causes and management of hypothyroidism during pregnancy： a study of 20 cases

作　　者：粱珊瑚[1] 余海英[1] 刘士春[1] 

机构地区：[1]深圳市妇幼保健院内科,518048

出　　处：《中国生育健康杂志》2013年第4期283-286,共4页Chinese Journal of Reproductive Health

摘　　要：目的了解妊娠合并甲状腺功能减退的病因，分析左旋甲状腺素片的疗效。方法收集20例妊娠合并甲状腺功能减退患者，采用左旋甲状腺素片治疗，定期监测甲状腺功能，及时调整剂量。结果自身免疫性甲状腺炎、甲状腺手术术后和^131Ⅰ放射性治疗所致甲状腺功能减退分别为60％、30％、10％。孕前期、孕早期、孕中期和孕晚期口服左旋甲状腺素片自身免疫性甲状腺炎分别为（33．3±2．4）、（43．1±3．1）、（46．9±4．3）和（57．3±3．9）μg／d；甲状腺手术术后分别为（83．3±4．7）、（84．4±5．0）、（87．5±4．9）和（92．9±5．3）μg／d；^131Ⅰ放射性治疗后分别为（87．5±4．8）、（106．3±4．1）、（112．5±5．6）和（118．8±5．5）μg／d；各组孕晚期所需的左旋甲状腺素的剂量均高于孕前；自身免疫性甲状腺炎各期所致甲减所需的左旋甲状腺素的剂量，明显小于甲状腺手术术后和”‘I放射性治疗组，差异均有统计学意义；新生儿甲减筛查均未发现甲状腺功能异常。结论自身免疫性甲状腺炎、甲状腺手术术后和^131Ⅰ放射性治疗后是妊娠合并甲减的常见病因。采用左旋甲状腺素片治疗，根据甲状腺功能调整剂量，孕期及时增加用量，对妊娠合并甲状腺功能减退患者具有良好的治疗作用，不会导致新生儿甲状腺功能异常。Objective To investigate the possible causes of gestational hypothyroidism, and to assess the effect of levothyroxine in treating the disorder. Method Twenty cases of patients with hypothyroidism during pregnancy were in- cluded. Levothyroxine was administered, with regular monitoring of thyroid function. Adjustment of the dose of levothyrox- ine was made according to clinical symptoms and laboratory results. Results The proportion of autoimmune thyroiditis, thyroid operation and postoperative ^131Ⅰ radiation caused hypothyroidism accounted for 60%, 30% and 10% of the total ca- ses, respectively. The dose of levothyroxine needed within cause-specific subgroup of patients increased with gestation. The average dose for autoimmune thyroiditis induced hypothyroidism required was the lowest, while the average dose for radia- tion induced hypothyroidism was the highest. Conclusion Autoimmune thyroiditis, thyroid operation and postoperative ^131Ⅰ radiation therapy are common causes of pregnancy complicated with hypothyroidism. Levothyroxine tablets has good therapeutic effect in the treatment of thyroid function, with adjustment of dose according to stage of pregnancy.

关 键 词：妊娠 甲状腺功能减退 左旋甲状腺素片 

分 类 号：R581.2[医药卫生—内分泌]